Decomposing educational inequality in maternal mortality in Iran

Area of Science:

• Public Health
• Social Epidemiology
• Health Disparities

Background:

• Educational equality is a key social determinant of health, significantly impacting maternal health outcomes.
• Understanding educational disparities in maternal mortality is essential for targeted public health interventions.

Purpose of the Study:

• To assess maternal mortality inequality based on maternal education level in Isfahan, Iran.
• To identify the main social and healthcare contributors to educational inequality in maternal deaths.

Main Methods:

• A case-control study utilizing data from the national maternal mortality surveillance system (2001-2016).
• Concentration index and curve were employed to measure educational inequality in maternal mortality.
• Chi-square test and decomposition models were used to identify contributing factors.

Main Results:

• The normalized maternal mortality concentration index was -0.13, indicating inequality favoring more educated mothers.
• Social factors, particularly mother's education level (38.14%) and immigrant status (25.39%), were major contributors to inequality.
• Healthcare factors, including proximate medical causes (14.49%) and number of pregnancies (9.72%), also contributed to educational inequality.

Conclusions:

• Maternal mortality exhibits significant inequality across educational levels in Iran.
• Interventions aimed at promoting health literacy, especially for women with lower education, are imperative.
• Addressing social and healthcare factors contributing to educational disparities is vital for improving maternal health outcomes.